Amputation and Replantation

Abstract

In the past 30 years, replantation surgery has evolved from something to make medical headlines to something that is almost routine. There are now generally accepted indications and contraindications for replantation, as well as accepted techniques for replantation. With regard to appropriate candidates for replantation surgery, a traumatic amputation of the hand through the wrist in a young or middle-aged employed adult is generally considered an appropriate candidate for replantation. Single digits are generally not appropriate candidates, unless that digit is the thumb. The thumb is quite important functionally, and, in the event that replantation of the thumb cannot be accomplished and loss of the thumb is complete down to the level of the metacarpal head, appropriate treatment could include a microneurovascular free toe transfer. In a patient with clean, multiple-digit amputations, however, replantation of all the amputated parts would be considered an appropriate option. Multiple-level amputations of a digit or digits, crushing injuries, a warm ischemia time of over 24 hours, ring avulsion-type amputations, or amputations in psychotic individuals are generally cases that are considered contraindications for replantation surgery.